April 6, 2018

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Dr Anna Rolleston

Understanding Definitions of Health

Dr Rolleston argues we have an Illness System, not a Health One.

The worst thing about writing is having to write about yourself, in my opinion. So I’ve decided not to. It would seem right to have an introduction here, a bit about who I am and why I have the privileged position of being able to offer my opinion in this forum. However, one of the things wrong with this world we live in, are the judgements we make on others based on a whole heap of information that is written abut them, and talked about them, and yet we’ve never actually met them for real. Also when we’re asked to tell others about ourselves its never a very accurate descriptor. We’re either too boastful or too humble and therefore such a descriptor means very little. So based on that, how about we take this leap together. Just read the blog, contemplate it and care not for the person writing. I’ve already got plenty of people who I am grateful care about me, you spend your energy caring about the people you love.
What’s wrong with the health system? How long have you got people? This could take a while.

Let’s start with the term ‘health system’. By my reckoning there is no such thing as a ‘health system’ because I’m not sure that we actually do ‘health’ at all. We do illness. But we certainly don’t do ‘health’.

Do you go to your doctor and say “Hi, I just came to make sure I’m still in peak physical condition?” If you have done that before I’d be keen to hear your doctor’s response. In general, we only access the ‘health system’ when we are not (wait for it) ‘healthy’. So it’s not a health system it’s an illness system and it only works well (supposedly) when you are already ill. Did you know that coronary bypass surgery, which is when you get new arteries put in around your heart when your actual ones get clogged with gunk and don’t let blood through, costs somewhere in the vicinity of $35,000 - $50,000? Imagine if the government gave you that money to buy healthy food, a pair of good shoes to exercise in and the services of a rongoa practitioner to support your whanau. Imagine.
But you can’t have that money sorry. You can’t have it unless you are ill (well you can get money to fund something when you are ill but not for food, shoes or rongoa). So, we don’t have a ‘health system’ we have an illness system. Illness costs lots of money by the way. Imagine how much money we’d have if we actually had a health system.

The health system is run largely for and by people who deal in physical health. Lets just call these people doctors for the sake of this blog. [By the way if there are any nurses reading this who think they might complain because I’m privileging doctors you might just want to read on before you get too upset, you may find you don’t want to be tainted by the brush I’m using]. Doctors know lots about the body. How it should work and what to do when it doesn’t work. Doctors, or western science and medicine at least, are a good part of the reason why we live longer than generations before us (although I note here that my great great grandfather lived well into his 100’s which is a feat these days let alone in the late 1800s when you were Maori). Doctors know their stuff and all credit to them.

BUT, there is more to me being human than just this body that surrounds me. I have a mind. I have a soul or an essence or a whatever you want to call it in your world. I also have these people around me who I love and when they are well, I am well and when they are not well, then neither am I.

In the health system, my sore tummy can be fixed by taking a medicine to calm the acid down. But what if my sore tummy is happening because I am frightened about something. Surely it makes more sense to help me feel less frightened or remove the thing that is frightening me, than to fix the end product of being frightened? Ah, but being frightened is not physical so it can’t be easily helped in the health system. Imagine if it could be helped.

Which brings me to the next problem. Why don’t we fix the actual problem rather than putting some kind of ‘gap filler’ around the problem. Symptoms and signs of illness are quite easily remedied by medication. I have high blood pressure, I take a medicine and abracadabra, my blood pressure comes down. So, does that mean that now I am healthy? Does that mean I don’t have high blood pressure anymore? I think it just means that I’m ignoring the actual problem and taking the ‘hear no evil, see no evil, speak no evil’ approach to health. If I can’t see it, then it’s not there. This is what the health system does and therefore this is how users of the health system act. The health system does not say eat healthy food, be active, manage your stress levels and take some time out to relax, it says take this pill and all will be well. Really? When the leaky homes debacle started was the solution just to paint over the damp bit, so no one could see it? When your car stops going because it has run out of gas, does moving the needle on the fuel gauge help? Surely it does, it doesn’t look like its run out of gas now so shouldn’t it be all good? Yes, if you have high blood pressure you do need to take medication but imagine if we stopped people getting high blood pressure in the first place. Imagine if in addition to the medication, we gave you a 3-month plan to modify the actual cause of the problem – which is lifestyle – so that you could slowly reduce your reliance on the medication. Imagine. Wouldn’t this way also be cheaper than supplying a person with medication for the rest of their life? Medication is quite expensive by the way. Imagine.

There is more (lots more) to say of course, about the illness system and the way that it functions (or doesn’t function). However, the system is a massive beast and despite what I’ve said already, I’m not one for complaining, preferring to think about what could or should be done differently. So, let’s go with that thought. Imagine if you had no constraints, as much money as was needed, and a whole heap of creative innovators, how would you design a system for the health of people? What would be the values of that system? How would the system be managed? What would be the expected outcomes? Who would the system be accountable to? At The Centre for Health we ask every single person who engages with us the following question: “What does good health mean to you?” Regardless of the reason why they were referred, what illness they might have, or any other information that might lead us to make assumptions about them, we decide, with them, based on their answer to that question, a plan for health improvement. How I define good health might be totally different to how you define it, so at the Centre we can’t therefore make assumptions about what is important to you on your health journey. The other thing is that your definition of health is likely to change as life changes. Think about a 20-year-old versus an 80-year-old. It’s quite possible that their answers to the question are really different. Health should be whatever you define it to be for you and your family. You should be able to access health care that supports your definition of good health. Imagine.